title: Myeloablative cord blood transplantation in adults with acute leukemia: comparison of two different transplant platforms.
abstract: We compared the clinical outcomes of adults with acute leukemia that received single-unit umbilical cord blood transplantation (sUCBT) after conditioning with a busulfan/antithymocyte globulin (BU-ATG)-based regimen at University Hospital La Fe (n = 102) or double-unit UCBT (dUCBT) after conditioning with a total body irradiation (TBI)-based regimen at the University of Minnesota (n = 91). Nonrelapse mortality, relapse and disease-free survival were similar in the 2 groups. Multivariate analyses, showed more rapid neutrophil (hazard ratio [HR], .6; 95% confidence interval [CI], .45 to .80; P = .0006) and platelet recovery (HR, .59; 95% CI, .43 to.83; P = .002) after the BU-ATG-based conditioning and sUCBT. Although there was a lower risk of acute graft-versus-host disease (GVHD) grade II to IV (HR, 2.81; 95% CI, 1.75 to 4.35; P < .001) after BU-ATG and sUCBT, the incidences of grade III to IV acute and chronic GVHD were similar between the 2 groups. Regarding disease-specific outcomes, disease-free survival in both acute myeloid leukemia and acute lymphoblastic leukemia (ALL) patients were not significantly different; however, a significantly lower relapse rate was found in patients with ALL treated with TBI and dUCBT (HR, .3; 95% CI, .12 to .84; P = .02). In the context of these specific treatment platforms, our study demonstrates that sUCB and dUCBT offer similar outcomes.
authors.affiliation: Department of Hematology, Hospital Universitari y Politècnic La Fe, Valencia, Spain. Electronic address: sanz_jai@gva.es.
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
authors.forename: Todd
authors.initials: T
authors.lastname: DeFor
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.forename: Veronika
authors.initials: V
authors.lastname: Bachanova
authors.forename: Ignacio
authors.initials: I
authors.lastname: Lorenzo
authors.forename: Erica
authors.initials: E
authors.lastname: Warlick
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunstein
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005312:Fetal Blood / Q000166:cytology* / Q000276:immunology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute leukemia; UCB transplantation